Mail Order Scum

Now everyone knows that nobody is safe from The Angry Pharmacist(tm). I always wonder why I never get featured in Drug Topics or any other pharmacy magazine that pharmacists read while taking a dump. I guess I’m too hard core (or use bad words way too often) to be in any cool magazines. :(
Oh, yeah, mail order pharmacies.
Lets just say that I hate Mail Order Pharmacies. Plain and simple. If you work for a Mail Order pharmacy, seek a career as a prostitute or maybe a Drug Rep or something. My hatred is from a multitude of colorful points that every retail grunt knows:

  • Mail order places get kickbacks from the insurance companies. Yes, I said kickbacks (not rebates, but fucking bribes/kickbacks). Why cant retail pharmacies dispense a 3 month supply for 1 copay (without losing money, a la Walgreens Medicare part D). Why do mail order joints get special deals on “Mail Order Only” test strips and supplies? Why do mail order (and hospital) pharmacies get special price breaks on generics? Oh, kickbacks. Did I mention that some insurance companies will only allow 3 fills at a retail pharmacy before mandating the patient use their mail order pharmacy? How can you say thats not kickbacks. Seriously, get your head out of your ass and wake up and realize that Mail Order pharmacies and the insurance company’s asshole they screw every night are making not only us retail folk look like money-grabbing bastards (“how dare you charge me $5.00 copay/drug a month! I get $5 for 3 months from my local mail order pharmacy!”) but………….
  • They waste our time! How many of you retail folks have had a Mail Order patient come in with a sad-panda face and an empty mail order bottle saying “Uh, my mail order medication got ‘lost in the mail(tm)’. Can I have a few atenolol so I dont die?” The Angry Pharmacist(tm) in me wants to say “Fuck you! You said that I was ripping you off for charging you a copay every month (because their insurance company wont let us fill a 90d supply, only their mail orders get to do that) and now you come begging and groveling to me for medication because it got lost in the mail? HAHAHAHA DIE!” but the actual pharmacist in me doesn’t want to see more of the MediCare money (that i’ll never see) wasted on a pointless ER visit (see DrugNazi, I care). So I charge him a whopping dollar for like a week of atenolol and send him on his merry way to go fuck me behind my back with his Mail Order Pharmacy mistress.
  • Patient comes in (who you know goes mail order) with a brand new testing machine. They plop it on the counter and wish to know how to use it. They said “The mail order pharmacy said to just take it in to any retail pharmacy and they’ll show me how to use it”. Uh, go fuck yourself? Do I work for the mail order pharmacy? Is my employer going to be happy that his over $1/min pharmacist is out helping a patient (who will never trade with us) with his machine that another pharmacy made a fat profit on? Let me consult you on the medications that Walgreens filled for you while I’m at it. We all know those chain pukes are too busy to actually do anything than shovel Rx’s out the door and drink coffee, so let me do their jobs for them (for free!).
    While I’m ragging on “The Pharmacy America Trusts(tm)(r)(blah)”, did anyone read the article on how a Walgreens DC has over 40% of its employees have a “physical or cognitive disability”? Now I realize this is a distribution center and not an actual store, but have you ever tried to get a copy from a Walgreens? Have you ever tried to speak with one of their clerks? Yeah, I’ll just stop right there. As a sidenote guess how many of my Walgreen buddies got a fax when that article came out. :) I’m so loved. Back to hating on Mail Order.

  • Doctors offices are even getting bribes from Mail Order joints. We have had more than one patient suddenly (and unknown to him/her) that all of his Rx’s were mysterously filled by a mail order pharmacy (we tried to fill them, and the insurance company gave the reject). A few phone calls later we found out that this Mail Order pharmacy that “partners with the doctor” magically got a full copy of all the meds this patient was on, and filled them without the patient even knowing what was going on. The pretense was that the medication was going to be “Waiting for the patient in the doctors office” so they “Didnt need a trip to the pharmacy”. Did I mention that said mail-order joint filled a 3 month supply when the insurance company put a 30 day restriction on retail? Amazing how fast the claims got reversed when the word “kickback” and “bribe” got thrown around between us and said Doctor/Mail Order Pharmacy.
    So what can us retail folk do about this? Complain to the insurance companies? No, they are in on it. Complain to the Doctor? They don’t care, not their problem. Complain to the State Board of Pharmacy? HA! The Mail Order place is in another state, good luck!
    Guess we bend over and take it. The problem is that unless we are total incompassionate dicks (not only a failure to our profession) and make folks go to the ER when their mail order shipment gets “lost”, they will never learn. Unfortunately I’ll be the first to admit that even I am not that much of an asshole. I have to ™ my shit or else the angriest pharmacist will steal it(tm). Heh.

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  • 27 Comments

    1. AZ RPh says:

      Charge your full cash-price, including dispensing fee, for whatever 7-day supply you give them. Let them get reimbursed from their insurance company, even if they say that “the insurance company said you should call for an override.”

    2. #1 Dinosaur says:

      Hey, I’m not getting any money from anyone. Best guess is that the insurance sent the mail order pharmacy the patient’s drug list; they faxed me and said, “Sign here; your patient wants to switch to mail order to save big bucks [on all my generic Rxs.]” They’re gang-banging you, me and the patient all at the same time.

    3. BlueTech says:

      Wow…that makes me feel subhuman…I work at WG and you’re right, every other store I work at besides my home store is filled with dumbasses. Actually, so is my home store…we just don’t let em near the drugs.

    4. MattCPhT says:

      Ok, I am just a tech, but I am also a pre-pharm student, so when I read this I see my future going down the drain. I HATE mail order pharmacies. There is all of this talk about the personal service pharmacists are supposed to give, and these places have NEVER seen thier “patients.” Even at my big chain employer (CVS, the only one who would give me a job) We do very well with giving the customer all the counseling and help they might need.
      The worst thing is getting a perscription that the patients will NEVER cover, spending an hour on the phone just to find that out, then playing phone tag with the Doc to get it changed to something they will pay for, and then being informed 2 months later that the patient must have MY HARD EARNED SCRIPT filled by mail order! (*breathe*)
      Anyway. I wish all the mail-order pharmacies would just disappear.
      Ok, I’m done. It’s someone else’s turn to vent. :)

    5. John Roman Rph. says:

      Well said.

    6. Shana says:

      I just found out that my insurance changed and I will have to pay half price at a retail pharmacy starting Jan 1st. The worst part is that the insurance company is going to force the mail order to change my medicines to formualary drugs. And they aren’t even going to tell me. Mail order sent me accolate even though I sent in prescription for singluair. I didn’t want the accolate and I had to pay for it anyway. And I always get screwed in terms of 30/90 day supply. No matter how the script is written, they seem to only want to send me 30 days. What a great savings to me!

    7. pharmgal says:

      I am a pharmacy extern and worked at a clinic on one of my rotations. Those freakin mail order pharmacies would send faxes to the clinic saying they needed refills on Pt. John Smith’s meds – on Pt John Smith had NEVER used this mail order pharmacy, but, SURPRISE, was instantly signed up when you mistakenly “refilled” his rxs. So everytime we got one of those we would have to call the pt and ask them if they actually use the mail order pharmacy. Nine times out of ten the answer was no. I hate mail order pharmacies as much as you do.

    8. L.S. says:

      I am simply a fan after reading this for 24hrs (with a few breaks). I have been a member of The Medical Community for >19yrs. …………… oh, sorry, had to vomit out some of the truth. I’m back now. I agree with every word of the “The Angry Pharmycist”, as I have lived them, and others, after working in large and small ED’s, HHA’s, Detox Centers (who take Medicaid, by the way) over a wide area of the DFW Metroplex. What a fucking nightmare. Oh yeah, if I had any imagination at all, I would start a blog about the Phych end of things, and HMO’s, etc… yeah, all of that shit, but it has been beat out of me by hospitals, HMO,s, Insurance co’s, Heathers, Nurse Nancys, Prima doc’s, etc…Oh, so tired. Thank you, today, for this rant. If only I had any brain cells left.

    9. jeve says:

      Hey We Doctors don’t get no stinkin kickbacks. Just like you, the insurance company tells us where to send the damn prescriptions. The patients come in with their twenty scrips needing rewrites for the mail away pharmacy. Usually I write duplicates for the mail away and the local pharmacy, but they inevitably change insurances and three months later need a do over. jeve

    10. Gary says:

      Argh. I feel the pain angry and I am right there with you on this. If we could only say “go fuck yourself” and send them on their merry way that would be awesome but most pharmacists wont. (Dont know about all of them)

    11. RxDr says:

      OK, you had me up until you indicted the hospitals for this ‘kick-back’ thing as well. I’ve NEVER gotten a ‘kick-back’ from a drug company. Hell, even getting rebates is a serious pain in the azz anymore. With the latest regulations that ‘favor’ you guys, the ‘price-breaks’ we used to get for PPIs and every other drug are now gone. We pay the same amount of Nexium PO that you guys do even though we purchase 15 times as much as you do in a year. You must have heard that when you buy in volume, you can always get price breaks…. That’s the deal with almost everything…drugs included. That’s why the mail-order pharmacies are kicking retail azz. It’s because they represent a central purchasing distribution center…. If you were Aventis would you want to sell 30,000 doses to one mail-order place, or 10 doses to 3000 separate small pharmacies in the U.S.? Granted, I know everyone buys from wholesalers, but that doesn’t guarantee much of anything. We are a non-profit, non-‘healthcare system’ hospital, so we don’t have much ‘buying group power’…. So unfortunately we don’t get great price breaks either…. Folks have to realize that the REAL problem is with the industry and the prices they sell the drugs for…rebates or no rebates….

    12. boundbyinsurance says:

      Most patients would greatly prefer to come see our neighborhood pharmacist for our meds. Our insurance companies are the ones who try to keep that from happening. If it makes you feel any better, my company tried to prohibit us from having any maintenance meds (which they defined as anything needing more than one refill) filled at our local pharmacy. There was such an outcry that they changed the policy. Now we can get maintenance meds filled locally, but we pay a $5 premium for generics and a $10 premium for brand names for the privilege of having a human being in front of us to answer questions.
      BTW, we used to get 90 days for a 60-day copay. Now it’s full copay for the 90 days, but we don’t get stuck with the retail pharmacy surcharge. So what used to be a real cost savings is now just a “use our mail order pharmacy or pay through the nose” transaction.

    13. ricki says:

      I’m just a lowly patient, but I hate mail-order pharmacies, too. Fortunately my current health-insurance provider allows me to use a real pharmacy (one in the town where I live, where I can go and pick up what I need when I need it), but my dad – who is on all kinds of meds – has to use mail order, as per the requirements of his pension plan (It’s that, or pay full-freight for the meds at a real pharmacy).
      More than once they’ve failed to arrive on time. More than once he’s had to spend hours on the phone arguing with some tech in New Delhi or somewhere to “prove” that yes, indeed, he needs a refill of Coumadin…I could understand reluctance to refill a pain medicine, but a blood thinner? Or his blood pressure meds?
      Not all folks who use mail order pharmacies are doing it to try to screw pharmacists out of a few bucks….for some people, it’s the choice between “pay a co-pay” and “pay $750 a month for the medication that keeps you alive”

    14. hiptocode says:

      i work in a doctor’s office, and I HATE MAIL-ORDER PHARMACIES. not only do they want a new written rx every time, but most of them will not let us fax, the dr. has to write out the rx and then i have to listen to the dr. bitch and moan and “why can’t you just call it in.” and the mail-order asses will not accept “such-an-such #30 1 qd with 2 refills” they will only fill “such-and-such #90 1 qd.” this is just the tip of the iceberg . . . i don’t even want to start on prior auth.

    15. rph3664 says:

      Did you read the article accompanying the Walgreens story? I did, and I actually saw that when it was broadcasted.
      It’s a distribution center (i.e. warehouse), NOT a pharmacy!
      And I once worked in mail order. (rph3664 puts on a flameproof suit)

    16. RJS says:

      1) You don’t have the staff to handle the load from mail order pharmacies if they disappeared tomorrow.
      2) I get one of my meds via mail-order, because I got tired of paying 3 copays when I could do 1 instead. I’m not an idiot for doing this.
      3) You bitch and moan about “kickbacks”. Sounds to me like you’re a whiney independent pharmacist pissed off because you don’t have the economies of scale that a mail order house does. (And neither do the big chains, incidentally.) Since you’re throwing out some pretty serious accusations, you should offer some sort of proof. But since you’re full of shit on this particular point, you can’t. Go ahead, though, I’ll wait to see what you come up with.
      Yeah yeah insurance companies are the devil, I won’t argue with you there. You’re not stupid, you knew that before getting into this business.
      4) I called Walgreens last week for a transfer, and I got some kid with a fucking stuttering problem. “W-w-w-waaaa m-m-m-may I [something]?”
      “Uh, what?”
      Repeats himself.
      “Uh, what?”
      Repeats himself.
      “I have no idea what you’re saying to me. I need to speak to the pharmacist.”
      “W-w-w-algreens m-m-may I h-help you?!”
      “Oh. That’s what you said. I need to speak to the pharmacist.” (Thinking “WTF” at this point because I had the pharmacy for 5 seconds before they put me on hold for ten minutes then this kid picks up the phone, and I’m thinking I got transferred to a psych hospital or something.)
      How in the fuck is this good customer service?

      “Ok, I am just a tech, but I am also a pre-pharm student, so when I read this I see my future going down the drain.”
      TAP is a drama queen. It’s what makes his writing compelling. It’s like dessert, a little is good, a lot is just sickening. You need more than just TAP if you want to get an accurate picture of the profession today. Enjoy it, but don’t read any more into it than one man’s thoughts. Always remember that someone has been prophesying doom and gloom for every profession on the goddamn planet since time began. Pharmacy included. You might want to diversify your reading a little bit, and read someone like Jim Plagakis instead of just TAP.
      If you hate retail pharmacy, it’s probably because you have/had a shitty mentor.
      And don’t ever say you’re “just” anything. Let your words speak for themselves.
      The impression I get is that TAP is also an independent pharmacy elitist. (After all, everyone else is “shitting on the little guy,” why not the big chains, too?) Most of the chain stores in my area are run far more effectively than the few independents around here, which leads me to believe it’s a local problem for him.
      You can still do a great job working for a big company, and you still deal with the same ground-level shit as anyone else behind the counter, independent or otherwise.

    17. rph3664 says:

      (rph3664 keeps flameproof suit on regarding previous comment)
      What’s going on with the comments? I can’t access them.

    18. PharmChick says:

      UGH! I had a pt come up today wanting to transfer her mailorder rx, just to use a freaking coupon to get 25 dollars in free grocerys. I had to leave a freakin message and wait for the mail order pharmacist to call me back. In the mean time, the pt is standing there looking at me like, “what the hell’s your problem and why aren’t you giving me my gift card for free grocerys?” UGH!!!! I hate coupons!!! Anyone else’s chain do coupons?

    19. Jimbo says:

      Either your mailorder pharmacy fucked up or you did. In any case I fail to see how this is my problem. Do you think not having your prescription is an emergency? Then maybe you should go to the emergency room and get an Rx.
      PS
      I work for a Mega corp and constantly get questions about scripts filled at other pharmacys. First question I ask is “What is your name?” “You should really talk to the Pharmacist who filled your RX.”

    20. rph3664 says:

      Okay, now I can access the comments. My mail order experience was as a senior student in 1993-94 and for 2 years after I graduated. I would probably still be working there if the headquarters had not decided to shut our location down. The pharmacists I worked with were the cream of the crop across the board, and morale was probably the highest of any employer I have ever had, pharmacy or otherwise, until we got the news that we would lose our jobs – and just before Christmas to boot. Talk about having the rug pulled out from under us. I no longer live in that city, but not one person I worked with has ever said they regretted working there.
      Things have definitely changed regarding tactics and mail order. Some of the things described in this thread are, IMHO, unethical. I also have a HUGE problem with insurance companies REQUIRING mail order for maintenance meds; the option should be there, again IMHO.
      Lots of our clients were retirees who, for example, wanted their meds sent to a relative’s address because they were living out of their RV. We also dealt with a lot of things that no retail pharmacy really wants to handle, namely human growth hormone or recombinant Factor VIII.
      Our biggest annoyance was people who sent in things like amoxicillin. We proposed a packing slip that said something like, “In the future, use your local pharmacy for short-term or acute meds.” We once got Lortab and Zovirax faxed to us on a Friday night from an ER, and a full message machine on Monday morning from an irate woman who wanted to know where the hell her meds were. Long story made short: Our fax technician said to me, “I hope it doesn’t work.” ROTFLMAO
      Towards the end, we got the Screen Actors Guild contract. Was that an interesting experience! I once spent an afternoon calling movie stars to ask about drug allergies, and we knew a well-known actor was terminally ill 6 months before it hit the tabloids. Unfortunately, we had to deal with a lot of Beverly Hills Dr. Feelgoods too.
      Whenever speakers came to our city for CEs or conventions or whatever, they knew to keep their mouths shut about mail order because they knew we would all be there.
      It does have its place but has been misused on many, many levels.

    21. rph3664 says:

      Pharmchick, when I worked in retail, the grocery store had free ham coupons at least once a month. It was annoying because people would delay having new prescriptions filled because they knew we would soon offer free hams, and we had one guy who would collect a bunch of coupons and he and his wife would come in when different people were working so he could get 6 or 8 free hams. We finally had to post a note under the counter when he came in. This majorly pissed him off and he even complained to the store manager, but too bad.
      We once had a woman who came in with 2 coupons and amoxicillin prescriptions for two children, and apologized when she asked because she felt she was ripping us off. I replied that it was “One coupon per customer” and her children were separate customers, so it was legitimate. I don’t mind that kind of thing.
      BTW, at this store, telling a customer not to come back, even covertly, was a firing offense. We had to be very subtle about it because the store director always sided with the customers, no matter how legitimate our complaints were or how ludicrous theirs was. A drug addict that the local ER turns away? Too bad, he spends money here so you have to fill his prescriptions?
      Example: This store was on a state border; we took our own state’s public aid but not the one across the river. The Walgreens across the street did. One day, a regular customer who was newly eligible for the other state’s public aid (because she had cancer) came in and I told her we did not take that plan. She told the manager that I had refused to fill her prescriptions and I practically had to twist his arm to convince him of my point of view. We were not going to take that other state’s public aid, BTW, because they can be up to a year behind in making payments. In case you’re wondering if that state was Illinois, you were right.

    22. rph3664 says:

      Regarding that Accolate/Singulair switch: Neither drug was on the market when I worked at the MO place, but several times, we were presented with comparable switches (i.e. blood pressure meds in the same class) and the contracting companies stopped asking us to do it because so many of us flat out refused to do so.

    23. Maile says:

      I don’t have a clue about drugs and I am not even in the whole drug industry. The closest thing I have to pharmacy and drugs are friends in it and at one point in time I wanted to be a drug rep. Thanks for your insight, I am glad I never got into that profession. I think the only true requirement at the job fair to be a drug rep was to be blonde and beautiful. I guess I am neither so I took up a different type of sales. Maybe I am equally bitter at those companies.

    24. DownonthePharm says:

      So i used to work as a tech at express scripts.. then i got into pharmacy school. The worst days of my life were spent behind a computer typing away my wrists. Yes i hate the establishment.. i would love to see it burn down, sadly i think it is here to stay.
      You forgot to mention how patients would recieve those long ass packet inserts with their medications. How it would freak them out to no end.. so where do they end up asking their questions.. thats right retail.. only because you had to sit on the phone for 4 hours pressing 1 then 4 then cough 3 times then run around in circles till you lost your breath waiting for a “professional” to answer all your questions. Only to tell you they have to send that packet insert out to everyone because its the law and most of it doesnt even pertain to you because the listed material has only happend to 1% of the population.
      Keep on hatin’ angrypharmacist. You keep us pharm students entertained when the material in lecture gets boring. Trust me.. it looks more educational when we’re reading our laptops in the back of class instead of playing online games. 😉

    25. the1megsta says:

      I want to hear what you think about the new requirement that all medicaid scripts be written on tamper resistant paper (or they threaten to remove the reimbursement) and how AMP will kill the independent pharmacist in America…
      –An independent pharmacist at heart–but working for the federal government.

    26. RPh9773 says:

      You are right on. I am a Walgreens RXM(Manager) and have practiced retail all my career (27 years). Your rants about customers/insurance/reps and Walgreens are right on. Sad to say it’s not hard to slam Walgreens. Please don’t paint all Walgreens pharmacists with a broad (we are all idiots) brush. Tales of customers/patients/guests, doctors, drug reps, nurses and other pharmacists acting like ass holes are universal to the retail pharmacy profession. Always have been, always will be.

    27. Andrew says:

      Jut want you to know, you have been featured in Pharmacy Today in New Zealand :)

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